PROJECT SUMMARY Maintaining adherence to HIV treatment is a challenge and nonadherence is associated with heightened risks for secondary HIV transmission and poor health outcomes. In sub-Saharan Africa, an estimated one in three patients do not take antiretroviral therapy (ART) as prescribed and one in four disengage from treatment within a year of initiating ART. Adherence to care outcomes are even worse among older adolescents and young adults (young people) living with HIV (YPLH) who experience the highest rates of ART nonadherence, treatment attrition, and virologic failure compared to other age groups. Consistent with the Division of AIDS Research?s areas of High Priority, the current project targets YPLH using a novel mHealth gaming intervention in order to promote their adherence to HIV care. Candidate: The candidate is a clinical scientist with a background in clinical and community psychology. His prior research focuses on the development of interventions to prevent HIV infection among underserved youth, primarily in the United States (U.S.). He is applying for a five-year K23 Career Development Award in order to expand his expertise and support his training, mentorship, and research within a novel area of intervention in a sub-Sahara African country (Ghana). Mentoring: Six well-established researchers serve as mentors on this proposal. Each brings complimentary expertise consistent with the study?s aims and training objectives. Dr. Larry Brown is the Primary Mentor and has experience in creating mobile gaming interventions for YPLH in the U.S. Four other mentors are HIV-focused investigators with expertise in global health research (Dr. Matthew Mimiaga), studies in Ghana (Drs. Awewura Kwara and Margaret Lartey), and applied qualitative methods (Dr. Kate Guthrie). Dr. Beth Bock is an expert in mHealth interventions including the use of text messages to address substance use. Research: The aims of the proposed project are to (1) gather information on the barriers and facilitators to adherence to care among YPLH attending an HIV clinic in Ghana and gauge YPLH preferences for an mHealth intervention via in-depth interviews with YPLH , their treatment buddies, and clinic staff; (2) develop a Text- Based Adherence Game to promote adherence to care by consulting with an mHealth developer and conducting an iterative open trial of the intervention with YPLH (n = 24); and (3) evaluate the intervention for feasibility and preliminary efficacy with a small randomized pilot examining biobehavioral adherence outcomes over one year in a sample of YPLH who receive the Text-Based Adherence Game versus YPLH who receive the standard of care (n = 60). Training: Specific training overseen by the mentorship team through formal coursework, workshops, seminars, conferences, directed readings, clinical work, and mentored experiences will be received by the candidate. Areas of focus include HIV-focused research in sub-Saharan Africa, broadly, and in Ghana, specifically; methodological and technical mHealth skills; and knowledge of gamification. The candidate is institutionally supported by Rhode Island Hospital and the Alpert Medical School of Brown University.